Agenda item

The Chair asked Mr Stuart Lines, Ms Lynda Gibbon and Dr Tim Spicer to explain the responsibilities of Public Heath, NHS England (NHSE) and GPs in respect of the Under Fives Flu Vaccination Programme.

 

Mr Lines stated that Public Health had local responsibility for ensuring that the system was working properly and that as many children as possible received the vaccination. NHSE commissioned services with primary care.

 

Ms Gibbon stated that NHSE  commissioned GP providers to offer free flu immunisation to all eligible children. NHSE funded and monitored services and worked with CCGs to identify any sub-optimal performance.

 

Dr Spicer emphasised that the services were commissioned with individual providers. The role of the CCG was to improve the quality of primary care and to support practices in difficulties. In addition, it was responsible for some operational issues and working with 31 practices to gain consensus.

 

Ms Gibbon added that Public Health England was responsible for the national procurement of the vaccine. The vaccine was supplied free of charge to NHS commissioned providers.  NHSE monitored the uptake as GP providers were contracted to provide activity data on a weekly basis via the public health surveillance system. Public Health England was responsible for publicity and had produced a range of resources for parents.

 

Ms Gibbon responded to a number of queries raised by Councillor Vaughan. The current uptake figures for Hammersmith & Fulham were:

 

Cohort	Cohort of healthy children	Cohort with long term medical conditions
2 years	24.8%	36.4%
3 years	21.6%	33.8%
4 years	18.1%	42%

 

Ms Gibbon explained that the cohort of children with long term medical conditions sat within the cohort of all children/adults at clinical risk. Contractually, there were no uptake targets. The World Health Organisation target of 75% had been adopted as best practice. The contract for children with long term medical conditions which ran from 1 September to 31 March, would be reviewed mid-point and extended beyond March if necessary.

 

Similarly, there was no specific target for uptake amongst healthy children. The aim was to exceed the previous year’s uptake.

 

Ms Gibbon stated that an example of sub optimal performance would be a practice not reporting activity data. The national IT issues in September, which had now been resolved, had impacted on initial data reporting.

 

Individual contracts had been put in place with independent GPs and community pharmacies across London. In addition, NHSE had developed a service level agreement for GP Practices to enable them to offer flu vaccinations to unregistered individuals who might present opportunistically or out of hours and to provide weekend sessions.

 

Councillor Carlebach stated that the figures quoted by Ms Gibbon were different from those given to him by the CCG. There were a number of key players but a lack of co-ordination. He had seen no plan or letter going out to children in the borough. There had been no letter given to children at his son’s nursery. There was no ownership of the programme. Hammersmith & Fulham was the worst performing borough across London in respect of vaccinations for pregnant women and people over 65.

 

Dr Spicer responded that he would ensure that Councillor Carlebach was provided with the correct figures.

 

Action: Dr Tim Spicer

 

Dr Spicer considered that for children with long term medical conditions, the vaccination should be part of their overall GP care. For well children, this was a new vaccination and it could take a number of years to get across the message to all parents and to change behaviour. Mr Lines added that the budget did not sit with Public Health, but the Council had supplemented the publicity  through the distribution of leaflets and posters to all 31 GP practices, primary schools, nurseries and libraries and also publicised it on the Council website and twitter feed.

 

Councillor Brown stated that at the previous meeting it had been agreed that a plan would be put together by the Council and the providers, and be shared with the committee. This had not happened.

 

Councillor Cowan queried whether Hammersmith & Fulham had the worst vaccination rate in London. Ms Gibbon replied that it was not the worst, but comparable. Councillor Cowan queried whether, if the NHS could not manage the vaccination programme, it could manage the wider responsibilities given to GPs and through Care in the Community. Ms Gibbon stated that the contracts ran to the end of March. The NHS was still actively delivering the programme and expected to move closer to the target.  

 

Dr Spicer stated that the CCG did not commission the programme or manage GPs, and therefore the flu vaccination programme did not reflect its abilities to manage the wider reforms.

 

Councillor Carlebach stated that he was seriously worried that vulnerable children in the borough were being left exposed. 

 

Councillor Cowan considered that the programme should be reviewed, to identify where not effective and to recommend improvements.

 

Mr Naylor noted that two years previously, GP practices had opened specifically to provide the flu vaccination and had employed additional staff. Dr Spicer was unable to comment on individual practices.

 

Councillor Carlebach stated that he had no confidence in the programme. He had not seen evidence of a plan or letters being sent and queried whether there had been contact with organisations such as Action on Disability and Mencap. Vulnerable people were at risk.

 

Councillor Lukey stated that at the last PAC, it had been agreed that there would be an action plan, and since that time there had been various meetings, including a meeting with Clare Parker, Chief Officer of H&F CCG. Councillor Lukey had personally checked on the availability of seven day opening and walk in centres. Dr Susan McGoldrick, CCG Deputy Chair had explained the process followed by GPs in respect of vulnerable children, and explained that parents not only got a telephone call but also a text message from their practices. A lot of work had been done in respect of raising consciousness.  However, there was still a lot of scepticism about the value of the vaccination, from both parents and older people.  It had been a major failure that NHS publicity did not explain that the vaccination was a nasal spray.

 

There was a particular problem with the number of people not registered with GPs, and a corresponding surge in parents taking young children to A&Es between 4pm and 7pm.

 

Councillor Lukey considered that the Council had made progress and worked conscientiously and tried to hold other organisations to account. It was a complex problem and the Council would keep working for the remainder of the flu season. There were still opportunities to get things done, but from 1 April there needed to be a joint campaign to improve figures for the following year.

 

Councillor Brown considered that the Council should have negotiated with GPs to put  staff into children’s centres and nurseries. There should have been a programme in place for people cared for by Adult Social Care cares and e-mail information provided to other groups. There had been a missed opportunity to do more. 

 

Councillor Cowan responded that the Council was reviewing how children’s centres could be used for the provision of health care and to promote all aspects of public health.

 

Councillor Cowan considered that there seemed to be no strategic control over the actions of individual GP practices. Issues such as the flu vaccine should be dealt with in the light of best practice. The Council itself was in robust negotiations with all parties, and would continue to promote the vaccination and work with the NHS to put the borough in the top quartile.

 

Councillor Vaughan concluded the discussion and summarised the key conclusions and recommendations;

 

1.    There had been an offer by the different parties to work constructively to promote the vaccine for the following year.

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2.    The CCG considered that it had communicated with GP practices and that the flu vaccine had been publicised, but the committee’s impression was mixed on this point.

 

3.    There appeared to be a fragmentation of responsibilities, with NHSE commissioning the providers and a mixed picture of communication by GPs.

 

4.    There were a number of issues around the take up of the vaccine, including communication that it was a nasal spray, rather than an injection.

 

 

RESOLVED THAT:

 

1.    The PAC recommended that the Council and partners should continue to work together to promote the vaccine during the current year.

 

2.    The partners should work together to learn the lessons and drive forward the programme.

 

 

3.    There should be better communication nationally to promote the vaccine as a priority for under five year olds and that it is a nasal spray.

 

4.    The clear benefits for all age groups should be promoted.

 

 

The Chair proposed and it was agreed by the committee that:

 

1, Item 8 be deferred to a future meeting: and

 

2.  the guillotine be extended to the end of the discussion in respect of items 6  and 7.